Sarah Key, author of 'The Back Sufferer's Bible' explains sciatica back pain
Sciatica is pain in the leg caused by trouble in the back. The pain can be confusing because it often masquerades as a pulled muscle, as if a cord has been pulled too tight through the back of the leg. The leg seems to crave stretching and shaking out, as if the muscles need un-knotting. Strangely enough, there may be no back pain.
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However, this is slightly a case of chicken and egg, since the leg muscles (buttock, hamstrings, calf) actually do acquire a low grade clench (we call it 'spasm') but it is caused by the back. Effective treatment usually requires treatment to both cause and effect;back and leg.
The sciatic nerve is made up of nerve roots that exit the spine between the lumbar vertebrae
The sciatic nerve is made up smaller nerve rootlets that exit either side of the spine through short bony canals between L1 and the sacrum. They can be compromised by excessive permanent compression of the lumber segments and by bloating of the facet joint capsule, the intervertebral disc, or both. The latter occurs when there is pathology of either structure.
Pulled muscles are often caused by sub-clinical back problems
Hamstrings, calf and Achilles tendon injuries are common to all sports. However they are often caused, at source, by undiagnosed (often asymptomatic) back problems. Even plantar fasciitis can be related to sub-clinical back problems (and to be effective exercises for plantar facsiitis must include spinal decompression).
In affect, covert sciatica problems 'tighten' the leg muscles and set them up for injury during the sporting exertion (including training). And all these annoying sporting injuries will keep happening if the back problem remains un-diagnosed and un-addressed.
Groins strain and other leg problems - including sciatica back pain - are more common with tennis and squash players, cricketers, soccer and rugby players where there is high impact with the ground that compresses their back. Participants in all these sports need to do preventative spinal decompression on a daily basis. Treatment for soft tissue strains of the leg is also necessary but it is secondary.
Sciatica can feel like a blood clot behind the knee
Sciatica can either be a referred pain from an unhappy facet joint, or pain caused by direct inflammation of a nerve root. Of the two, referred sciatic pain is much more common.
Referred pain is like a case of mistaken identity, where structures sharing the same nerve supply feel the pain as well. The pain of a heart attack, for example, on the left side of the chest and running down the left arm is another case of referred pain.
Less severe (chronic) sciatica usually presents as back of knee pain, invariably caused by an inflamed facet joint in the spine. Sciatic pain can can also refer down the back of the leg, the side of the thigh to the knee, or the front of the shin; the distribution depending on which level of the spine is inflamed.
In treatment for sciatic pain, referred leg pain is much easier to deal with than true sciatica or radiculitis caused direct inflammation of the nerve itself. Acute sciatica is a more severe pain, usually caused by a prolapsed intervertebral disc.
Radiculitis is caused by a pathological intervertebral disc bulge exerting pressure on a nearby nerve root and creating a toxic inflammatory climate. The cocktail of irritation is both physical and chemical as the nerve is scalded by the sick disc leaking out inflammatory products. Generally speaking, the more severe and the broader the spread of sciatic pain, the more severe the inflammatory focus in the back.
With sciatica back pain, different fibres of the nerve create pain in different parts of the leg
True sciatica is also associated with reduced straight leg raise (SLR) where having the leg lifted (when lying flat on the back) creates excruciating pain as it stretches the inflamed nerve. In severe cases it's not possible to get the leg more than a couple of inches off the bed before it's too painful.
Sciatica buttock pain is the most common form of sciatica. It typically manifests as a pain deep in the rump that makes you want to dig your fist in for relief. Sciatic lower leg pain is usually a development on from this. If a back problem is worsening, the pain will spread further down the leg. Conversely, as the back problem eases the sciatic pain withdraws up to leg to the buttock, and then into the back - before it disappears.
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